Liu Xinyu, Guan Hai-Ying, Zhu Qi, Tang Chaotao, Cheng Fei, Zeng Chunyan, Chen Youxiang
Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
J Gastrointest Cancer. 2023 Mar;54(1):155-164. doi: 10.1007/s12029-021-00739-2. Epub 2022 Feb 22.
With the continuous advent of magnifying endoscopy, endoscopic submucosal dissection (ESD) has gradually become the mainstream treatment for early esophageal cancer. We aimed to compare the outcomes of patients with T1 superficial esophageal cell carcinoma treated with ESD vs. esophagectomy.
We retrospectively analyzed patients who underwent ESD or radical surgery at the First Affiliated Hospital of Nanchang University from January 1, 2010, to December 31, 2018. The purpose of propensity score matching is to reduce selection bias. Precise subgroup analysis according to depth of invasion was performed to reduce the influence of confounding factors.
We reviewed patients who underwent ESD (n = 117) or radical surgery (n = 217) at the First Affiliated Hospital of Nanchang University from 2010 to 2018. The OS rate and progression-free survival rate in the ESD group were better than those in the surgery group (OS, P = 0.002. PFS, P = 0.004). The ESD group had a lower early adverse event rate (74.6% vs. 91%, P = 0.012), shorter hospital stays (median 10 days vs. 18 days, P < 0.001), and lower hospitalization costs (median 15,455 vs. 62,376 RMB, P < 0.001). Multivariate Cox regression analysis found that the treatment method was an independent risk factor affecting the prognosis of patients with superficial esophageal cancer, and the death risk of patients in the ESD group was 0.377 times that of the radical surgery group (HR = 0.377, P = 0.023). We conducted a subgroup analysis of patients again according to the depth of invasion; 37 pairs of patients were included in the T1a stage, and 19 pairs of patients were included in the T1b stage. In T1a and T1b patients, the difference in OS rate and PFS rate between the two treatments was statistically significant (T1a, OS, P = 0.002, PFS, P = 0.004; T1b, OS, P = 0.019, PFS, P = 0.022), and the OS rates in the ESD group were better than those in the radical surgery group.
For patients with T1b superficial esophageal cancer, ESD has a longer overall survival and progression-free survival compared with radical surgery. These results support ESD as the preferred treatment for stage T1b superficial esophageal cancer.
随着放大内镜的不断问世，内镜下黏膜下剥离术（ESD）已逐渐成为早期食管癌的主流治疗方法。我们旨在比较接受ESD与食管切除术治疗的T1期浅表食管癌患者的治疗效果。
我们回顾性分析了2010年1月1日至2018年12月31日在南昌大学第一附属医院接受ESD或根治性手术的患者。倾向评分匹配的目的是减少选择偏倚。根据浸润深度进行精确的亚组分析，以减少混杂因素的影响。
我们回顾了2010年至2018年在南昌大学第一附属医院接受ESD（n = 117）或根治性手术（n = 217）的患者。ESD组的总生存率和无进展生存率均优于手术组（总生存，P = 0.002。无进展生存，P = 0.004）。ESD组的早期不良事件发生率较低（74.6%对91%，P = 0.012），住院时间较短（中位10天对18天，P < 0.001），住院费用较低（中位15455元对62376元，P < 0.001）。多因素Cox回归分析发现，治疗方法是影响浅表食管癌患者预后的独立危险因素，ESD组患者的死亡风险是根治性手术组的0.377倍（风险比= 0.377，P = 0.023）。我们根据浸润深度再次对患者进行亚组分析；T1a期纳入37对患者，T1b期纳入19对患者。在T1a和T1b患者中，两种治疗方法的总生存率和无进展生存率差异有统计学意义（T1a，总生存，P = 0.002，无进展生存，P = 0.004；T1b，总生存，P = 0.019，无进展生存，P = 0.022），ESD组的总生存率优于根治性手术组。
对于T1b期浅表食管癌患者，与根治性手术相比，ESD具有更长的总生存期和无进展生存期。这些结果支持ESD作为T1b期浅表食管癌的首选治疗方法。
